Exam (elaborations)
NUR 4110 Final Adult 2 UPDATED
- Course
- Institution
NUR 4110 Final Adult 2 UPDATED
[Show more]
Seller
Follow
maggieobita
Reviews received
Content preview
NUR 4110 Final Adult 2 UPDATEDEye & Vision Disorders
Chapter 63
GLAUCOMA
• Damage to optic nerve related to increased IOP caused by congestion of
aqueous humor
o Aqueous production & drainage are NOT in balance
o Causes irreversible mechanical or ischemic damage CN 2 (optic) – causes
blindness
Risk factors
• African American • Previous eye trauma
• CV disease • Migraine syndromes
• DM • Near sightedness (myopia)
• Family history • Prolonged use of topical or systemic
• Older age corticosteroids
• Thin cornea
Diagnostics
• Tonometry – assess IOP (topical anesthetic applied first)
• Ophthalmoscopy – inspect optic nerve disc
• Perimetry – visual field assessment
Manifestations
• “silent thief” – gradual loss of visual fields may go unnoticed because central vision is
unaffected
• Early signs diminished accommodation & IIOP
• Difficulty adjusting eye to low lighting – difficulty focusing
• Aching or discomfort around eyes
• HA
• Primary open-angle glaucoma (most
Open angle = Over time
common) – silent thief
o Painless
o Vision ∆
o “tunnel vision” – peripheral vision loss
• Primary open-closure glaucoma = emergency!
o Sudden extreme pain
Closing door on finger = painful
o Blurring
o Halos around lights
o Ocular erythema
o N/V
Treatment
• Goal: prevent further optic nerve damage
• Maintain IOP within a range unlikely to cause damage
o Normal IOP: 10-21 mm Hg
• Pharmacologic therapy life long
o Miotics – constrict pupils
o BB – decrease aqueous production & IIOP
o A-2 agonist – decrease aqueous production
o Carbonic anhydrase inhibitors – decrease aqueous production
o Prostaglandins
• Laser procedures – used to open meshwork to widen canal
o Promoting increased outflow
• Angle-closure glaucoma
,NUR 4110 Final Adult 2 UPDATED
o Peripheral iridectomy – allows aqueous humor to flow from posterior to
anterior chamber
Nursing Management
• Med used may cause vision alterations & other side effects
o Explain action & effect to promote compliance
• Avoid anticholinergic meds – will increase IOP (ex: atropine, ipratropium)
• Post-surgery
o Avoid anything that will increase IOP
▪ coughing, sneezing, bending @ waist, N/V, no lifting heavy object, no
Valsalva maneuver (constipation)
o No driving
o Instill eye drops as Rx
o Don’t rub eyes, use contact lenses
o Wear sunglasses when in direct sunlight
o Feel itchy, blurred vision, eye tearing up more frequently = normal
▪ Will decrease over time
CATARACTS
• Opacity or cloudiness of lens – impairs vision
Risk factor
• Age – Increased incidence with age • DM
• Smoking • Obesity
• Long-term use of corticosteroids – especially high • Eye injuries
doses
• Sunlight & ionizing radiation
Types: Traumatic, congenital, Senile cataract (age related)
Diagnostics
• Snellen test – Decreased visual acuity
• Ophthalmoscope, slit lamp, or inspection – opacity of lens
Manifestations
• Early signs
o Blurred vision, painless
o Decreased color perception (brunescens – yellow-brown)
• Surroundings dimmer (as if glasses need cleaning)
• Absent red reflex
• Photosensitivity
• Myopic shift – able to read fine print again
• Diplopia (double vision)
• Reduced light transmission
Management
• Intervention indicated when visual acuity has been reduced to level that PT finds unacceptable
• Surgery – less than 1 hours (outpatient basis)
• Phacoemulsification:
o ECCE that uses ultrasonic device to suction lens out through tube
o Incision is smaller than standard ECCE
• Lens replacement:
o After removal of lenses by ICCE or ECCE – insert intraocular lens implant
o Eliminates need for aphakic lenses
,NUR 4110 Final Adult 2 UPDATED
o PT may still need glasses
• Pre-op Dilate eye (eyedrops)
o Every 10 min for 4 doses at least 1 hour before surgery
• Post-op:
o Call HCP immediately if
▪ Vision changes – Continuous flashing lights appear
▪ Redness, swelling or pain increase
▪ Type & amount of drainage increase
▪ Significant pain is not relieved by Tylenol
o Wear sunglasses
o Measures to prevent or decrease IOP
▪ Avoid lifting anything heavier than 15 lbs
▪ Sneeze with open mouth (decreases pressures)
o Turn client to back or non-operative side
o Position personal belongs to nonoperative side
RETINAL DETACHMENT
• Separation of sensory retina & retinal pigment epithelium
Patho
• Layers of retina separate due to accumulation of fluid between them
• Retinal layers elevate away from choroid – result of tumor
• When detachment becomes complete = blindness
• Rhegmatogenous detachment – most common
Diagnostics
• Visual acuity
• Indirect ophthalmoscope, slit lamp, stereo fundus photography, fluorescein
angiography – retina
• Tomography & ultrasound
Manifestations
• Sensation of shade or curtain coming across vision of 1 eye
• Bright flashing lights
• Sudden onset of floaters or black spots
o Sign of bleeding
• Hairnet like vision = priority
Treatment
• Scleral buckle
o Compresses sclera – choroid & retina together with splint until scar tissue
forms = closing tear
o Post-op care:
▪ Don’t sleep on affect side
▪ Don’t lay prone
▪ Measure to keep not increase IOP (sunglasses, no lifting, coughing etc.)
• Vitrectomy
o Intraocular procedure
o Gas bubble, silicon oil, perfluorocarbon & liquids – injected into vitreous cavity
▪ Float against retina to hold it in place until healing occurs
o Post-op care:
▪ Position – prone
Intervention
• Provide bed rest
• Cover both eyes with patch = prevent further detachment
, NUR 4110 Final Adult 2 UPDATED
• Speak to PT before approaching
• FOLLOW-UP danger of recurrence in other eye
• Avoid jerky head movements
• Post-op:
o Monitor for hemorrhage
o Notify HCP if –
▪ sudden, sharp eye pain
▪ new vision loss
o Deep breathing – NOT COUGHING
o Avoid measures that increase IOP
▪ Avoid squinting
▪ Sunglasses during day
▪ Eye patch during night
▪ Avoid rubbing/ scratching eye
▪ Avoid straining activities – ex: reading, TV, computer etc.
AGE-RELATED MACULAR DEGENERATION
• Deterioration of macula decline in central vision!
• No cure!
Types
• Dry or nonexudative – most common (age-related)
o Slow breakdown of layers of retina with appearance of drusen
o Gradual blocking of retinal capillaries leading to an ischemic & necrotic
macula
▪ Rod & cone photoreceptors die
• Wet
o Abrupt onset
o Proliferation of abnormal BVs growing under retina-choroidal revascularization
Diagnostics: amsler grid – grid will appear wavy
Manifestation: blurry spot in middle of vision Middle vision = macular
Treatment
• Interventions aimed @ maximizing remaining vision
• Photodynamic therapy – slows progression of Age-related MD
o Light-sensitive verteporfin dye injected into vessels
o Laser then activates dye shutting down vessels without damaging retina
o Result: slow or stabilize vision loss
o Post-procedure care:
▪ Avoid exposure to sunlight or bright light for 5 days after treatment
• Avoid activation of dye in vessels near surface of skin
HEARING & BALANCE DISORDERS
Chapter 64
CONDUCTIVE HEARING LOSS
• Caused by external or middle ear problem
o Any physical obstruction to transmission of
sound waves
Diagnostics
• Rinne test – mastoid bone tuning fork
o Normal: loudest in front vs behind ear
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller maggieobita. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $22.49. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
77988 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now